World AIDS Day: Getting key populations on the Fast-Track

December 1 marked World AIDS Day. A brief moment reflection our recent achievements in the fight against HIV and AIDS point to some significant victories. Globally, we have more scientific knowledge on how the virus is transmitted with prevention and treatment options being tailored to suit particular population profiles. The strategic response to the epidemic in Africa (UNAIDS Fast Track, 90-90-90 ALL –IN ) has kept pace with recent scientific discoveries. There are however challenges ahead and we cannot slow down efforts in the fights to reduce new infections.

While HIV rates have stabilised in some countries in Africa, admittedly at high levels, we are concerned about high incidence rates in key populations. Communities of people who inject drugs, sex workers, transgender people and men who have sex with men are among the hardest hit by the AIDS epidemic. HIV prevalence within these groups is 5–49 times higher than in the general population, and an estimated 45% of all new infections in 2014 were among key populations and their sexual partners. It is critical that we reach key populations with comprehensive HIV prevention services to achieve the global target to reduce new HIV infections to fewer than 500 000 by 2020. The concern is that few countries have mounted comprehensive responses for key populations. Stigma, discrimination and criminalisation are day-to-day barriers to services in too many countries. Further, insufficient domestic funding and a lack of social contracting for essential services are hampering prevention efforts. While basic prevention activities are essential tools, there is a need to strengthen and monitor HIV/SRH legal, policy and strategy environments for especially for young key populations. Young people within key populations face particular HIV risks, often due to lower knowledge of risks or lower ability to mitigate those risks compared with their older, more experienced counterparts.